WIN is Turning 40
Authors: Josephine P. Briggs, Mabel L. Purkerson
Journal: Journal of the American Society of Nephrology (2023)

Women in Nephrology (WIN) was founded in 1983, 40 years ago. This anniversary deserves celebration, an occasion to acknowledge the achievements of the founders and to celebrate the strengthened role of women renal scientists and nephrologists in the American Society of Nephrology (ASN). In this brief historical review, we provide some reminiscences on the early phases of WIN and some comments on the historical context of the founding. Women who remember those early days remember attending nephrology meetings as a lonely business. Presentations by women were rare, and the small numbers of women attending did not know each other or have ways to connect. But it was a time of change for both nephrology and for women in medicine. The early history of nephrology includes substantial contributions of pioneering women scientists, some of which have been summarized in a previous brief review.1 A few examples are Muriel MacDowell, in Jean Oliver's laboratory, performed the extraordinary microdissection of single nephrons that produced the camera lucida tracings and unforgettable drawings of single nephrons and their blood vessels; Phyllis Bott working in A.N. Richards laboratory developed nephron micropuncture techniques; and Margaret Mylle, in the Gottschalk laboratory, brought single nephron functional studies to new levels. Other women contributing to prominent work in that time include Gisela Schubert, in Munich, and Julia Troy, in Boston. These pioneers were largely behind the scenes, incompletely acknowledged and rarely on the podium. These women were critical for the work and the growing understanding of kidney function but limited in the roles they could play. They supported and implemented the chief investigator's projects, and their contributions received little recognition, and pay was low. Factors contributing to the limited recognition of these women include limited educational opportunities (a major obstacle being requirement for an advanced degree [MD or PhD], a protected male territory) and limited opportunities for academic appointments. In 1983, research was changing. Kidney physiology was well established as a solid area of scientific study, with leading medical institutions developing groups actively pursuing the investigation of kidney function. By the mid-seventies, the ranks of leading kidney researchers included a small number of prominent women scientists. Cell biologist Marilyn Farquhar was using tracers and electron microscopy to study the glomerular filtration barrier. Bodil Krogh Schmidt-Nielsen, who went on to be the first woman president of the American Physiological Society, was studying water balance in desert animals, work that clarified principles of the urinary concentration mechanism. In Australia, Priscilla Kincaid-Smith was making important contributions to understanding glomerular diseases. Nephrology was also changing as a clinical discipline. The biggest sea change was the development of methods to treat patients with failing kidneys. First chronic dialysis, followed by kidney transplantation introduced new possibilities for care of patients (and for the work of physicians expert in these diseases). Chronic renal failure was no longer a hopeless diagnosis, a change solidified by the monumental 1972 Social Security Amendment allowing funding of treatment of ESKD under Medicare. Throughout the 60's, the main forum for presentation of clinical renal research had been the clinical research meetings held each spring in Atlantic City. Change began with the establishment of the International Society of Nephrology and its first Congress in Evian, France, in 1960, followed 6 years later with the founding of the ASN and its first meeting in Los Angeles in October 1967. From the beginning, ASN provided a forum for interaction of scientists engaged in the new specialty, and ASN membership growth was rapid. Nonetheless, the numbers of women were not encouraging (Table 1). Noteworthy data were that in 1983, women accounted for 160 of total 3600 ASN members (4.5%). The 1983–1984 Directory of Medical Specialists identified 62 of 2069 American Board of Internal Medicine–certified nephrologists (2.9%) as women. At that time, the American Medical Association census reported that 9% of physicians were women. The proportion of women in nephrology (2.9%) was thus markedly less. Table 1 - Growth of Women in Nephrology Year Total ASN Members Women Members (Includes PhDs) Women, % 1976a 2300 66 2.9 1983–1984a 3600 160 4.5 1985a 3720 328 8.8 2023a (July 17, 2023) 17,862 5946 33.3 Total ASN Physician Members Women Physician Members Women, % 2023a 14,316 4448 31.1 Board-Certified Nephrologists ABIM added the subspecialty of Nephrology in 1972 1983–1984b: 2069 certified nephrologists, 62 were women (2.9%) 2023c: Per ABIM (https://www.abim.org/Media/vaqdilmh/candidates-certified-all-candidates.pdf) and direct communication with Dr. Rudy Rodriguez (Nephrology Section ABIM). 11,678 board-certified nephrologists, 3620 are women (31%) ABP added the subspecialty of Nephrology in 1974 2023d: Per ABP (https://www.abp.org/dashboards/pediatric-subspecialists-ever-certified). There are 709 board-certified in pediatric nephrology older than 70 yr. 443 are female (62.5%) ABP-certified in pediatric nephrology ASN, American Society of Nephrology; ABIM, American Board of Internal Medicine; ABP, American Board of Pediatrics.aData obtained from American Society of Nephrology membership files.b1983–1984 data shown by Directory of Medical Specialists.c2023 data from the American Board of Internal Medicine.d2023 data from the American Board of Pediatrics. One person who was paying attention to these numbers was Dr. Leah Lowenstein, a nephrologist and biochemist and Dean and Professor of Medicine at Jefferson Medical College, the first woman dean of a US coeducational medical school. In the late 70's, the American Medical Women's National Association convened meetings with the Josiah Macy Foundation to strengthen the role of women physicians,2 and the American Association of Medical Colleges (AAMC) held Executive Development Seminars for Women in Academic Medicine.3 Dr. Lowenstein was one of the leading voices in the American Medical Women's National Association and AAMC activities,4 and she brought discussion of these issues to the 1981 ASN Meeting and arranged informal gatherings of women nephrologists. The idea to establish WIN grew out of these meetings. In 1983, four women established a founding committee to develop a new professional organization. The WIN founders were Drs. Nancy E. Gary (Professor of Medicine—Nephrology, UMDNJ-Rutgers Medical School), Lois A. Katz (Associate Professor of Clinical Medicine, New York University), Sandra P. Levison (Professor of Medicine, Medical College of Pennsylvania), and one of us, Mabel Purkerson. All four had participated in conversations with Leah Lowenstein and the AAMC Executive Development sessions. The founders selected "Women in Nephrology" as the name of this organization, but from the beginning, membership was to be open to both men and women. Programs planned for presentation at WIN meetings would be on issues of general interest to all. Using their own resources plus some financial support from Boehringer Ingelheim, Ltd. and Travenol Laboratories, the organizers held the first WIN meeting on Monday evening, December 5, 1983, during the ASN annual meeting, in Washington. Dr. Gary, the first WIN President, was the speaker. Her address "Wither Thou Goest Woman Nephrologist" focused on the latest statistics about women in academic medicine and nephrology. At first, WIN encountered a chilly reception from the ASN leadership. Although the WIN team was determined to take a nonconfrontational open-to-all approach, ASN leaders were initially skeptical about the need for the organization. In the first year, President Gary and WIN President-elect Sandra Sabatini met on several occasions with ASN to discuss concerns. One major issue was that ASN policies stated that no other organization could have a scientific program that conflicted with any of the official functions of ASN. Drs. Gary and Sabatini reassured ASN that there was no desire to compete with ASN's scientific program and that the primary purpose of WIN was to foster a collegial relationship among women nephrologists. Their discussions and the exercise of diplomacy and patience by ASN and WIN representatives inspired trust and soon yielded a positive working relationship. Early support from the ASN Council set up in a process that enabled WIN to host a yearly meeting consistent with the ASN policies. ASN agreed to assign a meeting room for WIN for the annual lecture. ASN President Richard Glassock expressed willingness to promote the participation of qualified women on ASN committees and invited WIN to submit names of women members to assist with work on the various ASN committees. By 1985, ASN agreed to publish an announcement of the annual WIN event in ASN abstract and program book, ending the need to post meeting announcements in the ladies restrooms (see Supplemental Appendix 1). In the intervening 40 years, the ASN–WIN partnership has flourished. WIN has hosted a lecture on a current topic of broad interest at each ASN annual meeting (see Supplemental Appendix 2 for lecture titles and speakers and Supplemental Appendix 3 for joint activities). WIN presidents have been drawn from leading institutions across the country (see Supplemental Appendix 4). Women are now prominent contributors to all aspects of the Society's work. Most impactfully, six women physicians have been selected to be the President of ASN: Sharon Anderson, MD, FASN (2009–2010); Sharon M. Moe, MD, FASN (2013–2014);, Eleanor Lederer, MD, FASN (2016–2017); Susan Quaggin, MD, FASN (2021–2022); the current president Michele Josephson, MD, FASN (2022–2023); and Deidre C. Crews, MD, ScM, FASN, the current President-Elect. Factors contributing to the increase in the number of women members of ASN start of course with the increase in the number of women physicians graduating from medical school but have also been helped by the increase in the number and availability of nephrology training fellowship positions, increase in availability of kidney dialysis and transplantation for treatment of chronic kidney failure, and increased need for renal physicians to staff these units. WIN has done its part to promote careers in nephrology through encouraging the visibility of women nephrologists on ASN committees, in policy-making positions, on advisory councils, chairing symposia and ASN scientific sessions at national meetings. The last 40 years are clearly a WIN for women in nephrology.